I'm not one for themes - well unless it comes to planning birthday parties: CARS, Angry Birds or surprise parties for "big" milestones. In writing our weekly blogs, Lee and I have tried to weave a story about the use of disinfectants for infection prevention. However unintentional, this month, as I plan out topics for the blog, I'm seeing a theme develop - viruses.
In part the reason for developing theme is an article I read that was published in the October edition of AJIC by Tzialla et al titled "Viral Outbreaks in neonatal intensive care units: What we do not know". Not unexpectedly, infants admitted to NICUs are at risk for contracting HAIs and certainly over the past decade, the HAIs rates have steadily increased. However, the vast majority of outbreaks published in scientific studies focus on bacterial or fungal infections and certainly they do account for a significant portion of the outbreaks, the impact of viruses as nosocomial agents are not well documented.
Tzialla et al queried an outbreak database and found a total of 75 neonatal outbreaks of which 64 were directly related to neonatal patients and 44 (>68%) associated with NICUs. The top 5 causative agents were: Rotavirus (>23%), RSV (>17%), Enterovirus (>15%), Hepatitis A (>10%) and Adenovirus (>9%) with gastrointestinal system infections accounting for >54% of outbreaks and respiratory tract infections accounting for >34% of the infections.
From an infection prevention perspective, is there a common theme?
• From a microbiological perspective, Rotavirus, Hepatitis A, Enteroviruses and Adenoviruses are non-enveloped viruses. They tend to be hardier viruses that are more resistant to traditional disinfectant chemistries such as quaternary ammonium compounds.
• From a transmission perspective, Rotavirus, Enterovirus, Hepatitis A and Adenovirus can be transmitted via fecal-oral route - meaning the poor little neonate is eating poop!
• From a transmission perspective RSV, Adenovirus and Enterovirus are transmitted by contact with respiratory droplets.
• Transmission from contact with environmental surfaces and/or fomites has been documented.
• Many of these viruses increase circulation during the fall, winter and early spring.
We are well into Fall and what we typically call Flu Season, in fact there are only 46 more days until the first day of winter! While we often plan well in advance for Halloween, the Canadian and US Thanksgiving and Christmas holidays (there are only 49 more days to shop!), do we consider planning for "Virus Season"? Are there preventative measures we can and should consider putting into place? When was the last time you reviewed the efficacy claims of the daily disinfectant your facility uses? Does your product carry claims against Influenza, Norovirus, Rotavirus, RSV, Enterovirus, and Adenovirus? Do you have an infection prevention plan that considers making a change to a more efficacious product to help in the prevention of viral outbreaks? Do you increase the frequency with which high-touch hand contact surfaces are cleaned and disinfected in order to reduce the risk of transmission from contact with these surfaces? Do you have a readily accessible Fact Sheets that can be reviewed with staff to help them identify when they may be ill to help minimize the risk that staff are the source of the outbreak?
A fulsome program that considers (and hopefully implements) infection PREVENTION measures such as changing of disinfectant solutions or increased cleaning and disinfection can certainly be implemented with relative ease and likely contribute to fewer infections. The alternative of course is having to implement INTERVENTION measures to help combat a viral outbreak!